Hair Direction

The recipient sites are created to follow the direction and angulation of the native hair as it occurs naturally, by slanting the blade to mirror both the direction and exit angle of the hair. There is not a single pattern, exit angle or hair direction which is applicable to all patients. What is natural for one patient may be quite different for another. There is no one type of hair pattern, but there are some common trends. For example, in the central hairline, most patients’ hairs angle forward. This provides lift to the hair. However, on some occasions, patients have a cowlick, or other type of wave that persists in their remaining hair -in some cases the hair actually angles backward! In this instance, if transplanted hairs were angled forward, they would not blend properly. Dr. Keene takes into consideration the existing hair, since often we are adding to it, and not just replacing it. The grafted hairs will blend with the existing hair, not conflict with it.
Before and after images showcasing hair restoration results. The left side displays a person with noticeable hair thinning and receding hairline, while the right side shows the same individual with fuller, thicker hair after treatment. This comparison highlights the effectiveness of hair restoration methods for improving hair density and appearance. Ideal for those considering hair loss solutions, these images illustrate the potential transformation achievable through professional treatments.

Hair in the frontal scalp is typically oriented toward the face, which can be clearly seen when the hair is not brushed back. But the exit angle will be to the right or left, and sometimes will even converge toward the midline. Often hair will be angled very acutely near the hairline, becoming less angled as we reach the midfrontal scalp area above the ears. This angle becomes almost perpendicular to the scalp at the anterior crown where the curvature of the head begins to slope toward the back of the head.

Hairs on the sides of the head, and side burns, are generally oriented down toward the neck, and the exit angle is very acute.

Before and after 2250 grafts

Before and after images of a male undergoing hair restoration treatment, showcasing significant improvement in hair density and coverage. The left side displays thinning hair on the scalp, while the right side reveals a fuller hairline and healthier appearance. This visual highlights the effectiveness of hair restoration techniques in addressing male pattern baldness and enhancing overall confidence.

The crown hair usually exits the scalp in a whorl pattern. Some patients have more than one whorl.

The doctor will base the slant of the incisions on the direction of your native hair, maintaining the natural angle of that area. For the crown area, when there is no existing hair to indicate the original pattern, she will utilize her extensive experience and aesthetic talent in determining what looks natural.

Before and after 2250 grafts

Image showing two views of male pattern baldness, highlighting hair thinning at the crown. The left side displays significant hair loss with visible scalp, while the right side shows a slightly fuller appearance, indicating potential hair restoration progress. This comparison illustrates the effects of hair loss treatments and the varying stages of male baldness.

Dr. Keene believes the real benefit of using lateral incisions is when they allow for optimal recreation of the surrounding, or the presumed original exit angles.

Will I need to shave my head or cut my hair short?

As previously noted, just like other hair characteristics, hair angulation and directional patterns vary somewhat between patients, and depending on whether the hair is on the sides, or in the transition from the top to the sides. Dr. Keene has also observed that some patients have a “convergent midline angulation -meaning that hairs from either of the sides of the head actually angle toward the midline, while midline hairs angle forward. Dr. Keene believes that when existing hairs point the way, maximum naturalness dictates that she follows what nature has done.

Therefore, when patients have existing hair present in the recipient area, Dr. Keene does not shave it, because the visible hair as it naturally lies provides valuable information about the natural pattern of your hair growth. If you have hair in the recipient area, it is closely observed to recreate the naturalness of what you lost, matching the angle and direction to the hairs that are present. This also helps to minimize shock to the existing hairs by preventing slicing the follicles of existing hairs during recipient site creation.

When a patient has bare scalp, often there are tiny vellus hairs that can offer information about the original pattern of growth. But if not, the doctor will use her knowledge of frequently observed patterns of growth to orient the hair for its maximum benefit to you.

She also prefers that you not cut your hair very short, because that would impede her ability to see the natural direction and the way it lays, and it is an added inconvenience to you. If you have existing hair in the recipient area, it can help to camouflage the appearance of the surgical area in the immediate post surgery period, helping you to get back to work earlier, and giving you the choice of whether to share your surgical experience with co-workers, or keep your experience private. The existing hair is gently moved from side to side as we place the new grafts.